From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA (AT), Department of Anesthesiology, University of Texas Medical Branch, Galveston, Texas and Outcomes Research Consortium (RB), Department Anesthesiology and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA (HE, WASE, KM, EF, MS), Department of Quantitative Health Sciences and Department of Outcomes Research (NMZ) and Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio, USA (DIS).
Eur J Anaesthesiol. 2017 Mar;34(3):135-140. doi: 10.1097/EJA.0000000000000584.
Ultrasound-guided nerve blocks have become the standard when performing regional nerve blocks in anaesthesia. Infiniti Plus (CIVCO Medical Solutions, Kalona, Iowa, USA) is a needle guide that has been recently developed to help clinicians in performing ultrasound-guided nerve blocks.
We tested the hypothesis that femoral nerve catheter placement carried out with the Infiniti Plus needle guide will be quicker to perform than without the Infiniti Plus. Secondary aims were to assess whether the Infiniti Plus needle guide decreased the number of block attempts and also whether it improved needle visibility.
A randomised, controlled trial.
Cleveland Clinic, Cleveland, Ohio, USA.
We enrolled adult patients having elective total knee arthroplasty with a femoral nerve block and femoral nerve catheter. Patients, who were pregnant or those who had preexisting neuropathy involving the surgical limb, coagulopathy, infection at the block site or allergy to local anaesthetics were excluded.
Patients were randomised into two groups to receive the ultrasound-guided femoral nerve catheter placement with or without the Infiniti Plus needle guide.
The time taken to place the femoral nerve catheter, the number of attempts, the success rate and needle visibility were recorded. We used an overall α of 0.05 for both the primary and secondary analyses; the secondary analyses were Bonferroni corrected to control for multiple comparisons.
The median (interquartile range Q1 to Q3) time to perform the femoral nerve catheter placement was 118 (100 to 150) s with Infiniti Plus and 177 (130 to 236) s without Infiniti Plus. Infiniti Plus significantly reduced the time spent performing femoral nerve catheterisation, with estimated ratio of means [(95% confidence interval), P value] of 0.67 [(0.60 to 0.75), P < 0.001] with Infiniti Plus compared with no Infiniti Plus. However, Infiniti Plus had no effect on the odds of a successful femoral nerve catheter placement, number of attempts or percentage of perfect needle visibility.
We found that the use of Infiniti Plus decreased the median time to successfully place a femoral nerve catheter by 33% compared with not using Infiniti Plus. This difference may be more apparent to clinicians undertaking this procedure less often or by those in training as our team was very experienced, had been trained in the technique and was working in a hospital with a large caseload.
Clinicaltrials.gov identifier: NCT02080481.
在麻醉中进行区域神经阻滞时，超声引导下的神经阻滞已成为标准。Infiniti Plus（CIVCO Medical Solutions，爱荷华州 Kalona）是一种最近开发的用于帮助临床医生进行超声引导下神经阻滞的针引导器。
我们检验了这样一个假设，即使用 Infiniti Plus 针引导器进行股神经导管放置的操作将比不使用 Infiniti Plus 针引导器更快。次要目的是评估 Infiniti Plus 针引导器是否减少了阻滞尝试的次数，以及是否提高了针的可视性。
随机对照试验。
美国俄亥俄州克利夫兰的克利夫兰诊所。
我们招募了接受择期全膝关节置换术并接受股神经阻滞和股神经导管的成年患者。排除了孕妇或患有手术肢体神经病变、凝血障碍、阻滞部位感染或对局部麻醉剂过敏的患者。
患者被随机分为两组，一组接受超声引导下的股神经导管放置，一组接受 Infiniti Plus 针引导器。
记录放置股神经导管所需的时间、尝试次数、成功率和针的可视性。我们对主要和次要分析都使用了 0.05 的总 α 值；次要分析使用 Bonferroni 校正来控制多重比较。
使用 Infiniti Plus 时，放置股神经导管的中位（四分位距 Q1 到 Q3）时间为 118（100 到 150）s，而不使用 Infiniti Plus 时为 177（130 到 236）s。Infiniti Plus 显著缩短了股神经导管置入的时间，估计均值比数 [(95%置信区间)，P 值]为 0.67 [（0.60 到 0.75），P<0.001]，与无 Infiniti Plus 相比。然而，Infiniti Plus 对股神经导管放置成功的几率、尝试次数或完美针可视性的百分比没有影响。
我们发现，与不使用 Infiniti Plus 相比，使用 Infiniti Plus 可将成功放置股神经导管的中位时间缩短 33%。这种差异在较少进行或正在接受培训的临床医生中可能更为明显，因为我们的团队非常有经验，已经接受过该技术的培训，并且在一家有大量病例的医院工作。
Clinicaltrials.gov 标识符：NCT02080481。
